Print version ISSN 1413-8670

Braz J Infect Dis vol.16 no.3 Salvador May/June 2012

http://dx.doi.org/10.1590/S1413-86702012000300021

IDepartment of Dermatology and Venereology, The Second Affiliated Hospital, College of Medicine, Xi'an Jiaotong University, China IIDepartment of Infectious Diseases, The Second Affiliated Hospital, College of Medicine, Xi'an Jiaotong University, China

A 64-year-old man with cirrhosis associated with hepatitis B virus infection presented to the hospital with dystrophy and slurred speech for nine hours. He had been on lamivudine for five years. Physical examination showed uniform abnormalities of his fingernails (Fig. 1A). All of his fingernails revealed a distal thin brown to pink transverse band of 0.5-2.0 mm in width, white nail bed, and absence of the lunula (Fig. 1B), characteristic findings of Terry's nails.

This characteristic nail pattern is classically associated with liver cirrhosis.1 It is also associated with congestive heart disease, adult-onset diabetes mellitus, thyrotoxicosis, malnutrition, and advanced age.1-3 Fully developed Terry's nails exhibit a ground-glass-like opacity of almost the entire nail bed. The condition is bilaterally symmetrical, with a tendency to be more marked in the thumb and forefinger.1 The mechanism underlying white nails has not yet been clarified, although the pathological findings showed telangiectasias at distal band and proximal nail region.3 Neither hypoalbuminaemia or anaemia nor the severity of liver cirrhosis have a relationship with Terry's nails and the width of the distal color band of the nails.3

The most important differential diagnosis of Terry's nails is the uremic half-and-half nails, which are typically seen in chronic renal failure. The clinical differentiation of both nail-bed abnormalities are the transverse band in the latter commonly occupies 20% to 60% of the nail length.4 The easily recognizable abnormality of the nail bed should alert clinicians to the possibility of an underlying systemic disease, especially advanced liver diseases.